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The effectiveness of hypertonic saline and pentoxifylline (HTS-PTX) resuscitation in hemorrhagic shock and sepsis tissue injury: Comparison with LR, HES, and LR-PTX treatments

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 출혈성 쇽과 폐혈증 동물모델에서 Lactate ringer (LR)액, Hydroethyl starch (HES)-Hypertonic saline (HTS), LR-Pentoxifyline (PTX) 치료법과 비교된 고장용액과 펜톡시필린 혼합(HTS-PTX)치료의 효과 
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Dept. of Medicine/박사
The effectiveness of hypertonic saline and pentoxifyline(HSPTX) resuscitation in hemorrhagic shock and sepsis tissue injury comparison with the LR, HES-HTS, LR-PTX treatments Purpose: to compare the organs (lung and liver) injury and laboratory results of hemorrhagic shock and sepsis models with various treatments; HTSPTX, RLPTX, HESHTS and RL. Methods: Male Sprague-Dawley rats (200–290g, Charles-River, St. Constant, Canada) were used this study and they were randomly assigned to one of the four groups (n = 16 per group) to receive the following treatments: (1) lactated Ringer''s solution group (LR); (2) 7.5% hypertonic saline with hydroxyethyl starch group (HTS-HES); (3) lactated Ringer''s (LR) solution with PTX group (LR-PTX); and (4) 7.5% hypertonic saline with PTX group (HTS-PTX) and each group was divided to one of the two following event models; (1) hemorrhagic shock (n = 8); (2) sepsis (n = 8). The venous catheter was utilized for injection of resuscitative fluids, and the arterial catheter was used to withdraw blood and monitor the mean arterial pressure (MAP) by MacLab® (PowerMac, AD Instruments, Australia). Organ (lung and liver) histologiy study, Bronchoalveolar lavage (BAL) and Cytokine test were performed. Results: Mean lung injury score is 1.7. Total leukocyte count in the BAL 24 h after treatment was significantly higher in LR treated sepsis model (10 x 106 ±0.8) as compared to other sepsis treatment models (HTS-HES; 6 x 106 ± 1.2, LR-PTX; 5 x 106 ± 1.5, HTS-PTX; 5 x 106 ± 0.6)(p<0.05). The higher total leukocyte count in the LR sepsis model (17 ±1.5 %) is due to an increased number of neutrophils, as compared to other sepsis treatment models (HTS-HES; 6 ± 0.8 %, LR-PTX; 10 ± 1.3 %, HTS-PTX; 5 ± 0.4 %%). The total hepatic injury score in sepsis model was significantly greater in the LR group (9.9 ± 0.5) than either the other treatment groups (HTS-HES; 6.7 ±0.8, LR-PTX; 5.6 ± 0.7, HTS-PTX; 3.1 ± 0.9, respectively; p < 0.05). Also, in shock model, LR group (10.6 ± 2.1) was significantly higer (HTS-HES; 5.8 ±0.9, LR-PTX; 7.3 ±0.9, HTS-PTX; 3.5 ± 0.9, respectively; p < 0.05). HTSPTX resuscitation resulted in a 49% decrease in TNF-α, a 29% decrease in IL-1β, and a 58% decrease in IL-6 at 24 hours when compared with RL in shock model (p < 0.05) and, in sepsis model, in a 45% derease in TNF-α, a 24% decrease in IL-1β, and a 35% decrease in IL-6 at 24 hours when compared with LR (p < 0.05). Conclusion: HTS-PTX may have most advantage over other proposed resuscitation strategies and LR-PTX or HTS-HES was better results than LR therapy.
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